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On the 24th morning after the decampment of his wife, Patty Lareine (Debra Sandlund), Tim Madden (Ryan O'Neal), a former bartender and ex-con who was imprisoned for dealing cocaine, currently struggling to make a living as a writer and who is prone to blackouts, awakens from a two-week bender to discover a tattoo reading "Madeline" on his arm, and a bloodbath in his car. He shortly finds a woman's severed head in his marijuana stash in the woods, and the new Provincetown police chief Luther Regency (Wings Hauser) shacked up with his former girlfriend Madeleine (Isabella Rossellini).

Flashing back, Madden remembers the time when he encouraged Madeleine to go swinging with a Li'l Abnerish couple from down South, the fundamentalist preacher Big Stoop and his Daisy Mae-ish wife, Patty Lareine, whose ad Tim had come across in Screw magazine. On the trip back Tim and Madeleine's car crashes, due to Madeline being incensed that Tim has so enjoyed Patty Lareine's charms. The pregnant Madeleine loses her baby due to the crash.

Except for his father (Lawrence Tierney), who is dying of cancer, Tim suspects everyone, including Patty Lareine, multi-millionaire prep-school pal Wardley Meeks III — and even himself — of murder. Patty Lareine had left Big Stoop, married Wardley, left him in a messy divorce that netted her a rich cash settlement, and in turn married Tim, whom she fancied. Patty Lareine disappears, and Tim goes on his fatal bender that has left his memory in shards after receiving a letter from Madeline informing him that her husband (Regency) is having an affair with his wife (Patty).

Tim remembers his assignation in the local tavern's parking lot with the blond porn star Jessica Pond, while her effete husband Lonnie Pangborn watched from the sidelines, distraught. It was Jessica's head in the Hefty bag with his grass, but soon another head turns up in his marijuana stash, that of Patty Lareine.

Tim's father helps him get rid of the heads into the bay. Regency ultimately goes crazy and is shot by Madeline.

Tough Guys Don't Dance received negative reviews. It currently holds a 40% "rotten" rating at Rotten Tomatoes based on 20 reviews.[4]

Hal Hinson of The Washington Post said that the film was "hard to classify; at times you laugh raucously at what's up on the screen; at others you stare dumbly, in stunned amazement". Roger Ebert, in a ​21⁄2 star review in the Chicago Sun-Times praised the cinematography, the Provincetown setting, and said that the relationship between Tim and Dougy was the best aspect of the film, but also had to say that "what is strange is that Tough Guys Don't Dance leaves me with such vivid memories of its times and places, its feelings and weathers, and yet leaves me so completely indifferent to its plot. Watching the film, I laughed a good deal."

However, the film had at least two supporters. Jonathan Rosenbaum of the Chicago Reader, said "Norman Mailer's best film, adapted from his worst novel, shows a surprising amount of cinematic savvy and style." Also, "He translates his high rhetoric and macho preoccupations (existential tests of bravado, good orgasms, murderous women, metaphysical cops) into an odd, campy, raunchy comedy-thriller that remains consistently watchable and unpredictable—as goofy in a way as Beyond the Valley of the Dolls. Where Russ Meyer featured women with oversize breasts, Mailer features male characters with oversize egos, and thanks to the juicy writing, hallucinatory lines such as 'Your knife is in my dog' and 'I just deep-sixed two heads' bounce off his cartoonish actors like comic-strip bubbles; even his sexism is somewhat objectified in the process." Vincent Canby of The New York Times said that the film was "not the high point of the Mailer career, but it's a small, entertaining part of it".

In the years since the film's release on video, the film has become a cult classic in bad film circles. Channel 4 Film said "The overkill is strangely compelling and Mailer's disregard for taste and convention ensure his film is a massive but spectacular and unmissable folly." The film apparently got enough of a following for Metro-Goldwyn-Mayer, who owns much of Cannon's film library, to release an anamorphic widescreenDVD of the film on September 16, 2003. The disc contained an interview with Norman Mailer, a tour of Provincetown and the film's trailer.